ASO：胃癌TNM分期标准更适用于II/III型食管胃结合部腺癌分级

在2012年12月9日在线出版的《外科肿瘤学年鉴》(Annalsof Surgical Oncology)杂志上，发表了日本神奈川癌症中心Shinichi Hasegawa博士等人的一项研究结果，该研究对食管癌TNM分期标准还是胃癌TNM分期标准更适用于II/III型食管胃结合部腺癌(AEG)患者分级进行了阐明。这项研究结果发现，与食管癌TNM分期标准相比，胃癌TNM分期标准更适用于II/III型食管胃结合部腺癌(AEG)患者分级。该研究结果可能会对下一版食管胃结合部腺癌(AEG)患者TNM分级方法修订产生影响。

该项研究入选患者为II/III型食管胃结合部腺癌患者，并且这些患者曾接受D1或根治性更为彻底的巴结切除术治疗。研究人员按照第七版食管癌TNM分期标准及胃癌TNM分期标准，对这些患者进行分期。该研究还对患者分布情况、各期风险比(HR)以及患者生存率离散情况进行了对比。

该项研究共招募了163例患者。根据食管癌TNM分期标准及胃癌TNM分期标准，共分别有25例患者(20例与5例)以及32例患者(20例与12例)被认定为I期(IA与IB，15例患者(4例与11例)以及33例患者(11例与22例)被认定为II期(IIA与IIB，88例患者(24例, 3例与61例) 以及63例患者(14例, 26例与23例) 被认定为III期 (IIIA, III B与IIIC)，还有35例与35例患者被认定为IV期。研究人员发现，根据食管癌TNM分期标准，患者分布在IIIC期出现了大幅偏离，但根据胃癌TNM分期标准，患者分布则几乎保持均匀。研究还发现，根据胃TNM分期标准，HR呈逐步增加趋势，但未发现食管癌TNM分期标准存在该趋势。根据胃TNM分期标准，II期与III期患者生存率曲线出现明显离散(P = 0.019)，而根据食管癌TNM分期标准则不存在该现象(P = 0.204)。根据食管癌TNM分期标准，IIIA, IIIB以及IIIC期患者的5年生存率分别为69.0, 100以及38.9 %，而根据胃癌TNM分期标准，则分别为52.0, 43.4 以及33.9 %。

DOI 10.1245/s10434-012-2780-x
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Esophagus or Stomach? The Seventh TNM Classification for Siewert Type II/III Junctional Adenocarcinoma

Shinichi Hasegawa MD, Takaki Yoshikawa MD, PhD, Toru Aoyama MD, Tsutomu Hayashi MD, Takanobu Yamada MD, Kazuhito Tsuchida MD, Haruhiko Cho MD, Takashi Oshima MD, PhD, Norio Yukawa MD, Yasushi Rino MD, Munetaka Masuda MD, PhD, Akira Tsuburaya MD

Background The aim of this study is to clarify whether TNM-EC or TNM-GC is better for classifying patients with AEG types II/III. Methods The patients who had AEG types II/III and received D1 or more radical lymphadenectomy were selected. The patients were staged both by seventh edition of TNM-EC and TNM-GC. The distribution of the patients, the hazard ratio (HR) of each stage, and the separation of the survival were compared. Results A total of 163 patients were enrolled in this study. TNM-EC and TNM-GC classified 25 (20 and 5) and 32 (20 and 12) patients to stage I (IA and IB), 15 (4 and 11), and 33 (11 and 22) to stage II (IIA and IIB), 88 (24, 3, and 61) and 63 (14, 26, and 23) to stage III (IIIA, IIIB, and IIIC), and 35 and 35 to stage IV, respectively. The distribution of the patients was substantially deviated to stage IIIC in TNM-EC but was almost even in TNM-GC. A stepwise increase of HR was observed in TNM-GC, but not in TNM-EC. The survival curves between stages II and III were significantly separated in TNM-GC (P = 0.019), but not in TNM-EC (P = 0.204). The 5-year survival rates of stages IIIA, IIIB, and IIIC were 69.0, 100, and 38.9 % in TNM-EC and were 52.0, 43.4, and 33.9 % in TNM-GC, respectively. Conclusions TNM-GC is better for classifying patients with AEG types II/III than TNM-EC is. These results could impact the next TNM revision for AEG.